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<br />/" <br /> <br />ApPLICATION FORM FCT-3 <br /> <br />FLORIDA COMMUNITIES TRUST <br />FLORIDA FOREVER PROGRAM <br /> <br />1. PROJECT NAME <br /> (Descriptive project name) <br />2. APPLICANT NAME <br /> (Name of local government or nonprofit environmental organization) <br /> If nonprofit environmental organization, also provide the required information requested in Exhibit M and N, <br />3. PARTNERSHIP APPLICATION <br /> Is this a partnership application between two or more local governments or nonprofit Yes No <br /> environmental organizations. as described in Rule 9K-7,002(26). FAC,? <br />If "Yes," provide the name(s) of the local government(s) or nonprofit environmental organization(s), <br />4. KEY CONTACT PERSON <br />Note: The Key Contact is required to be an employee of the local government or designated representative of the <br />nonprofit environmental organization. Identify only one key contact person. <br />Key Contact Name <br /> First Middle Initial Last <br />Title <br />DepartmenVNonprofit Organization , <br />Mailing Address <br />City . FL Zip Code <br /> Note: If the applicant's principal office address is a post office box, a delivery address is also required, <br />Delivery Address <br />City . FL Zip Code <br /> Phone Number Fax Number <br /> E-mail address <br />Chief Administrator for the Locai Government (City or County Administrator) <br />Name: Phone Number <br /> , <br />5. PROJECT SITE LOCATION <br /> County Section Township Range <br />Note: Cite only one Section, Township and Range to indicate where a/l or most of the project acreage is located, <br /> Include a/l directional designations (Township either NoJth or South - - Range either East or West), <br />6. TOTAL PROJECT ACREAGE Acres <br /> Indicate the approximate acreage of the project site to two decimal points, <br /> <br />Form FCT-3 (Effective 2-21-05) <br /> <br />Page 1 <br />